ADRES and the capitation payment unit (UPC)
- System and programme
ADRES pools and manages the health system's money. The UPC is the fixed amount per enrollee that the system pays each EPS to cover the plan.
What it is
The Administrator of SGSSS Resources (ADRES), created by Law 1753 of 2015, pools the funds once handled by Fosyga and other funds, recognises and pays the UPC to the EPS, and makes direct payments to providers. The UPC is a per-capita amount that the system pays the EPS for each enrollee to organise and guarantee the services of the benefits plan. It is set according to the epidemiological profile of the population, the risks covered and the costs of care.
How it is organised
- Contributions, tax and solidarity resources and other sources of insurance funding flow into ADRES.
- ADRES recognises the UPC to each EPS according to its number of enrollees.
- The EPS uses the UPC to pay its IPS network and manage its enrollees' risk.
- Direct payment lets ADRES pay providers and suppliers on behalf of the EPS.
Worked example
- Made-up example: an EPS has 100,000 enrollees and receives an average UPC of 1.5 million pesos per enrollee per year.
- Annual UPC income: 100,000 × 1.5 million = 150,000 million pesos.
- If its enrollees use plan services worth 140,000 million, the margin for administration and risk is 10,000 million (6.7%).
- If an outbreak raises spending to 160,000 million, the EPS loses 10,000 million: it bears the group's risk.
- Reading: the UPC shifts financial risk to the EPS, which gains if it manages its enrollees' health well. The amounts are made up.
What the UPC pays for and what it does not
| Item | Paid by UPC? | Comment |
|---|---|---|
| Services and technologies of the benefits plan funded by the UPC | Yes | The EPS guarantees them through its network |
| Technologies not funded by the UPC | No | Prescribed through a separate route (MIPRES) |
| Explicit exclusions of Law 1751 | No | Not funded with public money |
| Collective public health | No | Funded from other sources, under territorial entities |
Markers
- ADRES
- UPC
- Fosyga
- Direct payment
- Capitation
In practice
- In practice, knowing whether a technology is funded by the UPC decides whether it is ordered by the usual route or through MIPRES.
- Problems in the flow of funds (debts between EPS and IPS) affect the timeliness of care.
Reference norms
- Law 100 of 1993, article 182: capitation payment unit.
- Law 1753 of 2015, article 66: creation and functions of ADRES.
- Resolution 740 of 2024 of the Ministry of Health (and its amendments): technologies not funded by the UPC.
Test yourself
Think of the answer, then tap the question to see it.
Which law created ADRES?
Article 66 of Law 1753 of 2015 (National Development Plan 2014-2018).
What is the UPC?
The per-capita amount the system pays the EPS for each enrollee to organise and guarantee the services of the benefits plan.
On what criteria is the UPC set?
The epidemiological profile of the population, the risks covered and the costs of care under average conditions of quality, technology and hotel services.
Does ADRES take on the functions of the EPS?
No: the law states that ADRES shall in no case take on the functions assigned to the EPS.
Connections
Educational content on epidemiological and statistical methods; the examples use made-up numbers to teach the calculation. Not a clinical or legal guide: current Colombian rules are in the official sources.
Sources: Ley 1753 de 2015 (Departamento Administrativo de la Función Pública, Colombia (Gestor Normativo), 2015); Ley 100 de 1993 (Departamento Administrativo de la Función Pública, Colombia (Gestor Normativo), 1993); ¿Qué es la ADRES? | ADRES (Administradora de los Recursos del Sistema General de Seguridad Social en Salud (ADRES), 2026); Compilación Jurídica SuperSalud - Resolución 740 de 2024 MSPS (Superintendencia Nacional de Salud, Colombia, 2024).
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Representative model, for educational purposes only.